Long Term Outcomes of Auxiliary Partial Orthotopic Liver Transplantation in Pre-Teenage Children With Fulminant Hepatic Failure.

Abstract

Objectives: To evaluate long-term outcomes of auxiliary partial orthotopic liver transplantation (APOLT) in pre-teenage children with fulminant hepatic failure (FHF). Methods: A retrospective chart review of thirteen pre-teenage children who underwent APOLT for FHF. Results: One case was done in 1997 and the remaining 12 since 2005. Recipients' left lobes were removed and either the left lateral segment or left lobe of the donor liver was transplanted. Etiology was unknown in the majority of cases (10/13, 69%) and was otherwise hepatitis A (n=1), autoimmune (n=1), and drug toxicity (n=1). All native livers showed submassive to massive necrosis at the time of transplantation. All children (100%) are currently alive with a median follow-up of 5.0 years (range 0.6-16.3 years). All children except one (92.3%) showed native liver regeneration. The first nine recipients (61.5%) are currently off immunosuppression (ISP) with fully regenerated native livers, and two additional patients are currently weaning off ISP. After the ISP withdrawal, the graft liver became completely atrophic in 6 patients and was removed in 2. Incidence of acute rejection prior to ISP withdrawal was 30.8% (4/13). Other postoperative complications included hepatic artery thrombosis requiring a second APOLT graft (n=1), bile leak (n=1), biliary stricture (n=1), bowel obstruction (n=1), anastomotic bleed (n=1), fungal peritonitis (n=1), abscess (n=3), CMV viremia (n=1), and de novo development of autoimmune hepatitis (n=2). Median post-transplant length of stay was 15 days. Conclusions: APOLT was successfully performed in pre-teenage children with FHF. This is the largest such case series reported to date, although previous smaller case series have shown similar good results. Recipients displayed native liver regeneration, and nearly all have been successfully withdrawn or are weaning from immunosuppression.